Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.

Adolescent Health and Behavior: Best Practice Strategies for an Underserved Population

GOALTo provide physicians and pharmacists with information on the best treatment strategies for the management of the adolescent patient.

TARGET AUDIENCEThis activity is designed for physicians who treat adolescent patients and managed care clinical decision makers. No prerequisites required.

LEARNING OBJECTIVESThe Johns Hopkins University School of Medicine and the University of Tennessee College of Pharmacy take responsibility for the content, quality, and scientific integrity of this CE activity. At the conclusion of this activity, participants should be able to:

Discuss the challenges that physicians face when treating adolescent patients.

Identify the methods of improving preventive and educational practices for the adolescent patient.

Evaluate the need for immunizations in adolescent patients.

Identify the methods to produce the ÒidealÓ adolescent healthcare visit.

ACCREDITATION STATEMENTThe Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The University of Tennessee College of Pharmacy is approved by the American Council on Pharmaceutical Education as a provider of continuing pharmaceutical education.

CREDIT DESIGNATION STATEMENT

The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

This program is approved for 2 hours (0.2 CEUs) and is cosponsored by the University of Tennessee College of Pharmacy, which is approved by the American Council on Pharmaceutical Education as a provider of continuing pharmaceutical education. A statement of CE credit will be mailed within 4 weeks of successful completion and evaluation of the program. ACPE program# 064-999-04-222-H01.

The estimated time to complete this educational activity: 2 hours.

Release date: February 15, 2004. Expiration date: February 15, 2006.

DISCLAIMER STATEMENTThe opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of the Johns Hopkins University School of Medicine and University of Tennessee College of Pharmacy names implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

This program is supported by an unrestricted educational grant from Aventis Pasteur.

Full Disclosure Policy Affecting CME Activities:As sponsors accredited by the Accreditation Council for Continuing Medical Education (ACCME) and the American Council on Pharmaceutical Education (ACPE), it is the policy of Johns Hopkins University School of Medicine and the University of Tennessee College of Pharmacy to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Program Directors and Participating Faculty reported the following:

PROGRAM DIRECTOR

Jonathan Ellen, MDAssociate Professor of Pediatrics
Johns Hopkins University School of Medicine
Baltimore, Maryland
• Dr Ellen reports having no financial or advisory relationships with corporate organizations related to this activity.

Julia McMillan, MDProfessor of Pediatrics
Vice Chair for Education
Residency Program Director
Department of Pediatrics
Johns Hopkins University School of Medicine
Baltimore, Maryland
• Dr McMillan reports having no financial or advisory relationships with corporate organizations related to this activity.

Notice:
In accordance with the ACCME and ACPE Standards for Commercial Support, the audience is advised that one or more articles in this continuing medical education activity may contain reference(s) to unlabeled or unapproved uses of drugs or devices.

Faculty have indicated that they have not referenced unlabeled/unapproved uses of drugs or devices.

Advanced Studies in Medicine provides disclosure information from contributing authors, lead presenters, and participating faculty. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

Adolescent Health and Behavior: Best Practice Strategies for an Underserved Population
Jonathan Ellen, MD,* and Julia McMillan, MD†

Considered neither adult nor child, the adolescent experiences abundant biologic and psychosocial changes. Growth in the area of healthcare provision to patients in this unique stage of life has lead to the development of the adolescent medicine subspecialty. Preventive medicine and confidentiality are 2 primary cornerstones at the heart of successful healthcare for adolescents. Because adolescents undergo dramatic developmental changes at various stages, their healthcare needs are complex and dynamic. Not only is each adolescent undergoing dramatic change, but the adolescent population as a whole has also changed over the past 15 years—in size and in racial and ethnic composition. In addition, the school environment has changed, with a decrease in the total number of schools, growth in the number of middle schools, and an increase in the size of schools. The purpose of this issue of Advanced Studies in Medicine is to review some of the challenges providers might encounter when caring for this distinct group of patients.

More than 4 decades ago, the Society for Adolescent Medicine was founded. Since that time, public and professional awareness about the importance of the physical and psychosocial health of adolescents has grown. As described in the first section of this issue, adolescents encounter many problems in accessing healthcare, including lack of health insurance, service-site location problems, scheduling difficulties, concerns over confidentiality, unavailability of experienced providers, and unavailability of providers who are sensitive to cultural, ethnic, and social diversity in the adolescent population. Current clinical guidelines support an annual, confidential, preventive services healthcare visit for adolescents; however, many adolescents are not receiving appropriate screening and education at these yearly interactions. A review of several factors to be considered in providing quality healthcare services for this population is provided.

Dr Jonathan Ellen provides an overview of the challenges to providing care to adolescents. He discusses how unique cognitive, biologic, and social developmental features of adolescence shape how care should be delivered, including the need for confidential services and well-trained providers.

Adolescents are prone to engage in a variety of risky behaviors as they struggle to feel autonomous and separate from their families. Unfortunately, these risky behaviors are not without consequence and are consistently associated with morbidity and mortality. In this issue, Dr Daryl Lynch provides an overview of some risky behaviors commonly associated with adolescents. Screening and preventive services that focus on these risky behaviors are clinically and socially important, as adolescents carry forward many dangerous habits into adulthood. Dr Lynch describes intervention techniques for the healthcare provider caring for adolescents.

Although major advances in the development and application of vaccination have resulted in the prevention and reduction of a number of infectious diseases, immunization efforts have generally focused on the preadolescent patient. The consequent elimination and reduction of many preventable infectious diseases, the changing epidemiology of many pediatric illnesses, and the introduction of new vaccines have shifted the focus of vaccination strategies to the adolescent population. Dr Lawrence J. D'Angelo reviews which vaccinations to administer by the onset of and during adolescence.

To be most effective, healthcare services directed toward the adolescent patient should provide for the biologic, psychologic, and sociologic needs of the patient and must be modified for the individual patient's developmental status. Adolescents receive healthcare advice from a variety of avenues, including school and the Internet. Dr Charles J. Wibbelsman reviews concepts essential for the ideal adolescent-medicine healthcare visit. Of utmost importance for the adolescent healthcare visit is confidentiality. The protections and limits of confidentiality must be explained to the adolescent in language modeled to meet his or her specific developmental needs. Advantages that the managed care environment offers for adolescents are reviewed, including prepaid healthcare in a quality, confidential, comprehensive clinic. Two adolescent patient cases in a group model health maintenance organization are presented, with an emphasis on confidentiality issues.

In adolescent medicine, the provision of effective screening and education has important health and social implications. As the general population continues to age, much of today's healthcare resources have shifted to the elderly. Providers of adolescent healthcare, however, must remain steadfast in their dedication to this important group of patients struggling to become healthy adults.